An Insiders View of "Sicko"

Like Bob, I haven't seen MM's newest "documentary" (although, to be fair, I'm not a big movie guy; the last film I saw was the new James Bond flick). But it appears I really don't need to:

"Ask any Cuban who has recently left the island (because they can’t talk freely about this inside of Cuba) about their health care system and they will tell you that it is often a challenge just to get aspirin and they often have to get it on the black market. The run-down, dilapidated and unsanitary conditions in the facilities that the average Cuban must go to for care are a far cry from the hospitals and clinics reserved for high-ranking members of the communist party or the military. There are actually special facilities in Cuba that serve foreigners who can pay in foreign currency."

Read the whole thing (scroll down, since the site doesn't use permalinks).

Why isn't health care compulsory?

[Welcome Junk Food Science and Industry Radar readers!]

I say it’s time for Congress to face up to Americans’ needs, and make health care compulsory.

I’m not talking about health insurance. I’m talking about health care. Health insurance is not the same as health care. Who calls their insurance agent when sick or injured? Who calls an actuary? Don’t real people call their doctor or go to the emergency room? Yet our so-called leaders go on and on about compulsory insurance as though insurance is what we need even though it’s obvious that health care is what we need. The public is being sold insurance when we should be buying health care. If anything needs to be made compulsory, it is health care – not health insurance.

Once this concept is understood, it's clear what must be done. First, all health care professionals become employees of the Federal Government, paid a living wage from public funds. Second, hospitals, clinics, labs and other facilities are nationalized and their staffs also become employees of the Federal Government. Fair compensation is paid to the former owners just as for the condemnation of any other private property for public use. Third, the Federal health care professionals examine any person who wants health care, and issue health care orders to anyone who is determined to actually need health care. Fourth, it is illegal to seek or receive health care from anyone except a Federal health care professional. Fifth, everyone in the country is included in the plan; however the full cost (plus an administration fee) for non-legal aliens' health care is charged back to their home country via the home country’s foreign exchange account maintained at the U.S. Treasury. Finally a system of regional Federal Health Tribunals will be established.

The Federal Health Tribunals are empowered to impose heavy fines upon individuals who shirk their civic duty to follow health care orders, including refusal to alter lifestyle when so ordered (e.g., exercise, stop smoking, lose weight). The Tribunals also have authority to order health shirkers confined until treated. Depending on the seriousness of the condition, the confinement may be in a hospital or if hospitalization is not required, to (a) the Governors’ mansion, (b) the home of any elected State or local official, (c) any residence maintained by a member of Congress, or (d) any private home larger than 3,000 square feet.

The Tribunals also have the power to order a provider who refuses to deliver care that is ordered by a regional Federal Health professional, to perform unpaid community service within the Tribunal’s region.

Refusal by a health shirker or a health care provider to comply with an order of a Health Tribunal will carry penalties similar to contempt of Court and may involve fines or imprisonment or both.

Making health care compulsory would address actual need. Public funds to pay for compulsory health insurance would not be wasted on “insurance” but would be spent directly for health care. Everyone would then be healthy, happy, and handsome, and all our children would be smarter than average. Overnight, our life expectancy would be the highest in the world and infant mortality would drop to zero.

I call on Congress to enact this plan now.

USFL has left the Building

As one might imagine, folks with diabetes, cancer survivors and other folks with significant health problems often find it difficult to obtain life insurance. For one thing, a lot of agents represent only one carrier, which are often picky. Even independent agents, though, aren't always aware of alternative markets for their difficult-to-place cases.

For a long time, most of us "in the know" have relied on US Financial Life as our "go-to" source for social smokers, folks who've had recent bouts with cancer, mutliple-bypasses, and the like. USFL has been "aggressive" in its underwriting, often taking cases that other carriers either declined or rated so drastically as to render the coverage unaffordable.

But the industry is changing, and this time for the better; today, I received an email announcing that the "impaired risk market served by USFL is limited in size and has come under economic pressure as traditional carriers are increasingly expanding into substandard risk classes. Given these challenges, AXA Financial has decided to discontinue writing new business at USFL." [ed: apology to readers; I'm still looking for a linkable version of the announcement]

In other words, more "regular" insurers are willing to look seriously at "problem cases," which means more choices for consumers. I've placed a few cases with USFL over the years, and been happy to have them in my "quiver of carriers," but I also like the idea that my clients will have more choices, and competition should help drive down costs.

We'll have to wait and see on that last, of course.

Oh, and what about in-force policies? According to USFL's prez, Tim Herr, "(e)xisting coverage will continue for clients: the terms and conditions of their policies will remain in place."

As it should.

Cavalcade of Risk #29: Submissions Due

Just a reminder that submissions for next week's CoR are due Monday (the 2nd). Our hostess, Wenchy at Wisdom from Wenchy, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

PLEASE NOTE: Due to the July 4th Holiday, next week's Cav will be posted on the 5th.

Also, we still have Fall '07 hosting slots available. Hosting is fun, easy, and gets you off the "nag" list. Just drop us a line!

Hospitals v Bloggers

Paris (Texas, not Hilton) is home to the Paris Regional Medical Center.

And so, you ask?

Turns out, a disgruntled blogger has been busy pointing out sundry (and alleged) nasty items about said health care institution.

Apparently, the bloggers* -- who have thus far remained anonymous -- claim that PRMC has engaged in various criminal enterprises, including Medicare fraud. In fact, it appears that the bloggers have been fed specific information from actual hospital employees, which raises a number of issues, not the least of which would be potential HIPAA privacy violations.

[*ed: At this point, it's not certain whether the blog is run by one person or several, so I went with the multiple to keep it simple]

The hospital is hardly taking this lying down; they've convinced a court to order the bloggers' ISP to disclose their identities.

As in the case of Dr Flea, there are a number of issues in play here. As The Assertive Patient notes, there are competing interests: "Is the blog uncovering wrongdoing by the hospital? And is the hospital retaliating by bringing the suit? Will the blog be protected by the First Amendment, as other publications are?"

It's not immediately clear that so-called "Shield Laws" will apply in this case. After all, these are not journalists, but bloggers. There's an argument to be made, however, that bloggers are "citizen journalists," and I wouldn't necessarily argue against that characterization. But it seems to me that this is far from clear-cut.

In the meantime, I suspect that this story will become the most recent cause celebre (literally, Celebrity Cruise) for the medblogosphere, and we'll keep IB readers informed as we learn more.

(h/t Industry Radar)

FFS & Medicare

According to Medicare, a Fee for Service (FFS) plan is "(a) type of Medicare Health Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan's payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn't cover."

In other words, a FFS plan stands in for Medicare and Medigap (aka MedSup or Medicare Supplement) plans. It takes one's Medicare reimbursement and liability "offline," and makes it more of a one-on-one arrangement with your provider, rather than the traditional third-party arrangement we've all come to know and (ahem) love.

With FFS plans, Medicare pays a private insurer (e.g. Blue Cross) so many dollars per month on your behalf, and the carrier pays any claims out of that stipend. If they miscalculate, or your health declines, they may end up paying out more than they got from the gummint; likewise, if you're relatively healthy and have few claims, they get to keep the difference.

Not exactly rocket science.

In fact, if you're so inclined, the folks at Medicare have made available a handy booklet that explains all about how these plans work, and can help you decide whether or not one is "right for you."

Once one has decided to give the FFS system a whirl, one needs to sign up (enroll) in whichever plan is currently offered and available. There may be more than one, or none at all. What's different is how companies that offer FFS's "incentivize" folks to choose theirs. For example, many (most?) folks find that the traditional Medicare system leaves a lot of gaps in their coverage, so they buy Medicare Supplement policies, often sold by insurance agents. Of course, these agents (such as yours truly) are paid a (very modest) commission for each sale. These commissions are paid by the insurance carrier with whom the policy was placed.

Until recently, Medicare Advantage plans (of which FFS's are a subset) were sold directly by the carrier, not through an agent. But FFS plans may be sold by agents, who are paid a fee (similar to a commission) for the sale. So far, so good.

Unfortunately, my industry has a long history of shooting itself in the foot (cf: Single Premium Life), and the FFS biz is no different:

"Humana Inc., UnitedHealth Group Inc. and five other U.S. health insurance companies agreed to stop selling a type of government-funded plan for the elderly in response to complaints that sales agents forged signatures and enrolled dead people."

Gotta love that last: I thought dead folks only voted in Chicago; who knew they also bought health insurance in Peoria? And it's a non-trivial amount of money, in that FFS plans "account for about 20 percent of the $60 billion Medicare Advantage program." Ouch.

In the event, Medicare is working with the carriers involved in this little kerfluffle to determine guidelines, and they've temporarily stopped pushing these plans until there's sufficient oversight and enforcement in play.

I was particularly pleased to see Bloomberg quote fellow medblogger Bob Laszewski, who opined that "(i)t's a positive development in that they are doing something, but it's somewhat hollow...Someone came up with a fantastic public relations marketing, failing to tell people that 99 percent of all sales occur during the open enrollment.''

Bob's referring to the fact that, perhaps not coincidentally, the aforementioned carriers have ceased their marketing efforts at the same time that the Medicare Open Enrollment Period is in hiatus.

Not that we're cynical or anything.

So what's the bottom line: are FFS plans a good thing or not?

Well, that depends, really, on what one expects from one's insurance. I've always been of the opinion that there are trade-offs in such plans: cost vs availability, exposure vs access. If one saves a bunch of money, but can no longer see one's trusted family physician, is the trade-off worthwhile? Seeems to me that that's a personal decision, pne not to be taken lightly or without some serious contemplation. On the other hand, no one's claiming that the plans themselves are defective in some way. If one knows ahead of time that certain provicers aren't going to be available, but that one's monthly premiums are going to decrease substantially, then perhaps it's a worthwhile trade-off.

Food for thought.

Surgery & Guiness: An Update

Seems our erstwhile surgeon-in-waiting has attracted the eye of John Law:

"A 15-year-old boy who allegedly delivered a baby by Caesarean section in an attempt to set a world record as the youngest surgeon apparently fled as police prepared to arrest him on Tuesday."

The gendarmes have apparently already arrested the miscreant's parents, and are on the lookout for Doogie, as well.

This doesn't appear to be headed towards a happy ending.

Sauce for Goose, #4

For all the enthusiasm expended by those who want to see Canadian-style, big government health care implemented here, I think it's fascinating that those who actually live it aren't necessarily so hot on it.

And it's not just a few grumbling malcontents who seem to prefer a more, oh, private type of system:

"Canada's top doctor singled out New Democrat leader Jack Layton yesterday for "hypocrisy" for undergoing hernia treatment at a private Toronto medical clinic.

But Brian Day, president-elect of the Canadian Medical Association, was quick to note Layton is in good company."

Turns out, former Canuck leaders Paul Martin, Jean Chretien and Joe Clark have all been availaing themselves of these private clinics (of which there are apparently quote a few, putting the lie to those who tout this as an ideal system).

And even among those who do choose the services of the nationalized system, a little "some are more equal than others" appears to be the order of the day:

"(U)nion leader Buzz Hargrove, president of the Canadian Autoworkers, proved a master at "queue jumping" when he got in for an MRI within 24 hours of injuring his leg."

"Queue jumping." Heh. Careful there, Buzz, don't want to sprain an ankle and require any more free health care.

But even those accused of "bashing" the Canadian system (such as Dr Day) aver that "(n)o doctor in Canada I know wants a U.S. system."

Sure, whatever you say, Doc.

An Inspiring Grand Rounds

Wandering Visitor asked contributors to this week's 'Rounds to send in posts about "Things that inspire you."

And boy, did she get a boatload: over 3 dozen posts, most of which followed the theme. It was interesting to see what kinds of things medbloggers find inspiring.

Dealing with two teenaged daughters, I was particularly moved by Nancy Bown's post on parenting as inspiration. She draws on the Virgina Tech tragedy, as well as her own experiences. Quite inspiring.

Monday Miscellany

■ A co-worker's husband (a minister, no less!) is blogging his trip to Israel. He left a bit over a week ago, and has a week more to go. He's posted some beautiful pictures, as well as his own observations and thoughts on where he is and what he's seen. Worth clicking.

■ A few weeks ago, I lambasted GE for its terrible customer service. In the meantime, I've had two extremely wonderful customer service experiences, which I'll share:

I recently "inherited" a Bang & Olufsen CD/Radio unit. It's quite beautiful, and I'm sure that it sounds great, but I had no way of knowing since I lacked the instructions. A quick perusal of the B&O website yielded no help, so I dropped the company an email explaining my plight. A few days later, I received a .pdf with everything I needed to know.

About the same time, I also "inherited" a whisk attachment for our Cuisinart Food Processor. Again, I was sure that it would be a terrific tool, but with no instructions, I had no idea how to use it. Same drill: cruise over to Cuisinart's website, poke around, no instructions, but a helpful contact form. Completed, submitted and waited. Lo and behold: last week I received a phone call from a Cuisinart rep, who offered to send me the instructions I needed, but lacked my snail mail address. The instructions arrived in todays mail.

Now THAT'S customer service!

Amazing Carnival Monday

This week, I was pleasantly surprised to see that we were included in both of the top finance-related carnivals:

The "Silicon Valley Blogger" (of The Digerati Life) put together a mind-numbing 91 posts for this week's Carnival of Personal Finance, all held together with a kind of fantasy-mythology theme. Believe it or not, it really does work; maybe a little better than most of us would have believed.

Of course, with that many entries, it's nearly impossible to pick out a favorite, but Kelly Bejelly, blogging at A Girl Worth Saving, tells of a harrowing experience with credit card/identity theft, how she handled it, and some pointers for the rest of us.

The Carnival of The Capitalists is at Management Professor Notes (II), hosted by Prof Sandy Kristin Piderit. The good professor presents 40 interesting posts, categorized and with helpful context.

Having recently written on the importance of customer service, I was drawn to Jason Rakowski's post which illustrated the concept of good vs bad customer service in an entertaining, and quite helpful, way.

Legal Eagle Carnival News

Regular Cavalcade of Risk contributor Eric Turkewitz recently tipped me to a weekly compendium of "(s)ome of the best of the recent blogs dealing with personal injury law (that I found)," the Personal Injury Law Round-Up.

It's actually quite interesting, and somewhat overlaps both the CoR and the Health Wonk Review. But it's different, too: if you've ever watched Perry Mason (or Boston Legal), then you won't be surprised by some of the antics chronicled by RU contributors. Check it out, you'll be glad you did.

Medical Tourism: Not What We had in Mind

Perhaps you've heard, but the son of not one, but two prominent Indian physicians has delivered a woman's baby.

And so, you ask?

And so: the young man in question is but 15 years old and no, his name is not Sumit Howzer. In fact, he's still in school (no, not med school, thank you very much). His father encouraged, and oversaw, the procedure because, well, "he wanted to see his son's name in the Guinness Book of World Records."

Well. Who could argue with that?

Oh, right:

"Amarilis Espinoza, a spokeswoman for the record book, said in an e-mail response to a question from The Associated Press that the organization doesn't monitor or endorse such feats because it would encourage the practice of "bad medicine."

Ooops.

At least mom and baby are reported to be doing fine.

Lose Some, Win Some

Regardless of where one stands on the gay marriage issue, it never seemed equitable to me that employers would offer "domestic partner" benefits to gay couples while giving hetero ones the cold shoulder. And now, it looks as if that whole kerfluffle may become moot:

"A Michigan court ruled in February that public employers may not offer benefits to unmarried partners, gay or straight, because of a 2004 amendment defining marriage. Government employers there had offered benefits only to gay couples."

Well, that seems to have settled that.

Or maybe not: there's an appeal currently wending its way through the Wolverine State's legal system, so we'll have to wait for the final word there.

■ Meantime, Kentucky's Attorney General has put the kibosh on two Blue Grass State universities offering those domestic partner benefits, again regardless of sexual orientation.

■ In Nebraska, a US Appeals Court upheld an amendment barring government agencies from offering such benefits to same-sex couples (although it didn't address unwed heterosexual partners).

■ And here in the Buckeye State, a lawsuit's been filed to prohibit my alma mater's (Miami University - Go Redskins!) from granting health and other benefits to same-sex partners of that institution's employees.

On the other hand, more and more employers are looking to "do right by" folks who adopt. According to USA Today, almost half of employers offer adoption benefits; that's a 25% increase from just a few years ago.

But just what does "adoption benefit" mean?

Well, that depends on whom you ask. Some employers provide cash-on-the-barrelhead for legal services, others give paid time off for folks to adjust to their newly-expanded families. The only downside is that, since these are not considered as benefits under 213(d), the proceeds themselves are taxable as income. Still, 75% of something is better than nada.

If you're thinking about adoption, you might want to check out this website for a list of which companies offer what additional benefits.

We Get Mail!

One of the great benefits to hosting a blog on insurance matters is that, from time to time, we’re offered the opportunity to help folks out. I really do mean that: all four of us really do enjoy helping people solve their insurance problems [ed: well, it sure ain’t for the money!]. We aren’t always successful, as you’ll see in this instance; what we’d really like is for our readers to offer any suggestions (and/or relevant experiences they’ve had). This can be done via the comments section, or by email. And now, our letter from Bruce*:

[*All names have been changed to ensure privacy. Content was edited for brevity.]

“I'm going to have a stroke or massive heart attack while talking to a medical or insurance institution.

I recently had a physical exam. My chief complaint was constant fatigue. The doctor said my lab tests were fine; it was most probably sleep apnea and I should go get a test to confirm.

I begin to wonder what this will cost. The web has informed me that the "test" is to spend the night in the hospital while being filmed and wired to recording devices. Sounds expensive [and] I wonder what the insurance will pay. I plan to ask the insurance company (BCBS), but know from experience that they do not like this question. I resolve to get the CPT ( Diagnosis code) and ICD9 (treatment code) from the hospital; the charges are $139 for ½ hour visit with doctor before the test and $3000 for the test.

I now call BCBS. I explain that I am trying to find out what my cost would be for a medical procedure before I commit to having it. [I am told] that the information I am asking for does not exist. Oh sure it does; I have the ICD9 code for her. She then asks me what hospital I am going to [and] her the hospital’s financial payer code. I do not have the answer, [so] this ends the conversation.

I really want to know, so I call again. This time I get Marvi [who] listens to my explanation and question. She asks me to wait a moment, and then comes back on line to say the ICD9 code I have given is invalid. I repeat the number in case we got it wrong. She is sympathetic but we can go no further. I now have the information that the insurance will pay for 90% of the usual cost after I pay the deductible. But of course without the ICD9 code I cannot know the "usual cost". One would think that the sacred ICD9 codes would be freely available on the web. I use Google and to my surprise I find the code. It is 89.17.

Now for the diagnosis code (CPT). I learned in another life that the AMA copyrights them and all users must pay a fee to have them. All I want is to be a responsible citizen and keep my medical expenses to those that I consider worth the money. This is a completely discretionary expense. I have no desire to have medical expenses that I don't need."

And there matters stand. The four of us have noodled this, and have thus far determined the following (which we’ve shared with Bruce):

1) He should consult with his HR folks to see what (if any) help they can be in this. (As it turns out, he had not already done so)

2) Determine if he has access to a Flexible Spending Account (to help mitigate his actual out of pocket costs)

3) Go to the carriers website to see if there are any transparency tools available.

So there you have it, dear readers. Any other suggestions?

Cavalcade of Risk #28 is up!

Julie Ferguson, of Workers Comp Insider fame, hosts this week's Cavalcade of Risk. She's put together quite the issue, with a record-setting 24 interesting risk-related posts. Please check it out.

And consider hosting a Cav yourself; Julie can tell you that it's easy, fun, and a nice traffic bump. Just drop us a line to sign up.

A Senior Moment

One of the neat things about SiteMeter is that one can see from whence our visitors have come. I've noticed that we've had several referrals from a new (to me) site, Health Management Rx. It's hosted by Jen McCabe Gorman, a Washington (DC)-based hospital/healthcare industry analyst and consultant.

Recently, Jen had coffee with an elderly gentleman with a unique -- and disturbing -- perspective on the state of elder care. Part 1 is here, and her follow-up is here.

Read both.

Dear Grand Rounds...

If you like Dear Abby (and even if you don't), you'll love this week's Grand Rounds. Geena, hostess of Codeblog, presents her 3 dozen-entry 'Rounds as an advice column, with some mighty fine entries.

My step-father, due to some health issues, must use an electric "scooter" to get around. On the one hand, it's an acknowledgement that his health has declined; OTOH, it's pretty cool (a jazzy red number, with a basket and headlight). As a guy, though, I'm sure he'd love the new models from Porsche (yes, that Porsche). Read all about some new "alternate transportation" options at Science Roll.

Excellent Carnival Monday!

Wow: Two outstanding business/finance related carnivals this morning. Be forearned, though, both are chock full of posts (not a bad thing, BTW).

We'll take them alphabetically:

The Carnival of the Capitalists, hosted this week at Blog Business World, features 30 posts in 5 categories. Most include helpful context, as well.

The issue of ethics has been a recurring theme here at IB, so I was impressed with this post at the Sox First blog. In it, host Leon Gettler poses a series of questions to help new employees understand how a given company handles ethical conundrums.

Meanwhile, over at the Carnival of Personal Finance, host JD (blogging at Get Rich Slowly) offers up a mind-boggling 85 posts, most with helpful commentary. He's sprinkled some cleverly-chosen videos throughout - a lot of fun!

Since this edition marked the second anniversary of the Carnival, the theme was "favorite posts" from the past two years, and a lot of folks (including us) took that seriously. And you'd think that with over 7 dozen choices, it'd be hard to pick a favorite.

But it really wasn't:

Some 16 months ago, Jim at Blueprint to Financial Prosperity penned a heartfelt and important reminder that the map is not the territory, and we are not our assets, but so much more. Recommended.

Do HDHP's cause people to learn about health care?

The June 13 Wall Street Journal contained an article on the growing influence of patient groups on medical research. The article states,

“Online patient groups have become an increasingly powerful force for health-care consumers over the past decade, raising funds for research and offering patient information and support. Now, as the cumulative power of their memberships grows, these groups are becoming invaluable partners to researchers and physicians searching for cures.”

This reminds me that the debate about high-deductible health plans may be missing an important point: HDHP’s are not the fundamental motive for patients to become increasingly informed about health issues, and are not the reason patients are trying to be “better shoppers” for health care. Instead, those developments were happening already - and independently. Access to health care information via the internet was around long before so-called “consumer-directed” health plans tiptoed onto the stage.

Viewed in this light, the true significance of the high-deductible plans may be that,

· AFTER consumers have influenced their health care treatment for the better

· based on more-informed discussion with their physician,

· the patient may realize some financial benefit, in some circumstances,

· from the health care choice they influenced

· because HDHP’s remove the insulation from costs that too many insurance plans provide.

But I do not believe that HDHP’s are driving some fresh new search by patients toward more health care knowledge. That search was already well under way; the key enabler is the internet; and as more and more people access the internet, the search for health indformation will continue to broaden and deepen.

Can the general public handle this new knowledge?

I think so. No one expects patients to become the equivalents of physicians, even tho some, as reported in the Journal article, will become very sophisticated. The general expectation is only to become aware of alternatives, possibilities, and relative costs (including approximate out-of-pocket costs).

The U.S. Census Bureau has estimated that, in 2007, a total of almost 21 million Americans cannot read a newspaper; cannot add, subtract, or balance a checkbook; cannot write a complete sentence; cannot speak - or can barely speak; do not vote; and are incapable of self-support. [Table 094 Midyear Population by Age and Sex.]

I’m referring to the population age 4 and below. Does the present ignorance of this population mean that we should expect these individuals can never learn how to be functioning members of our complex, modern society? Is it preferable to keep this population ignorant because someone might argue that learning is beyond their grasp?

I think the answer is self-evident: of course we can educate our children. Of course learning is not beyond their grasp. And of course we can expect our children to mature into self-sufficient adults.

In a similar fashion, I think it is a mistake to believe that the general adult public is incapable of absorbing increasingly sophisticated information in regard to their own health and health care.

The trend toward increasing general knowldege of health care is continuing - and IMO cannot be stopped. The so-called “consumer-directed” health plans simply provide a means and a financial incentive for knowledgeable individuals to pursue superior and in some cases lower-cost health care alternatives. We need not worry obsessively today about the growth of these plans. They will grow in proportion to the expanding health care knowledge of the population.

ADDENDUM: For a fascinating, real-time example of almost exactly the kind of issues Mike mentions, be sure to check out this post at Dr Wes' blog, and especially the comments section. HGS

Cavalcade #28: Submissions Due

Submissions for next week's CoR, hosted by Julie at Workers Comp Insider, are due this coming Monday (the 18th).

You can submit your (or someone else's!) risk-related post via:

Blog Carnival

or

Email

Please include:

■ Your blog's url

■ Your post's url

■ The trackback url (if applicable)

■ A (brief) summary

PS We're scheduling hosts for Summer '07, so don't wait too long to sign up!

A Bit of Back-Patting...

Found this whilst poking around our SiteMeter readings. It's healthcare100.com's World's Top Blogs on Health and Medicine:

We're in the top third (#31, to be exact), near our friends the Health Care Economist and the Health Affairs blog. Nice company, to be sure. I really don't know much about this site, but it's always nice to be in the upper levels of any "Top 100" list.

[ed: I'm sure that Bob will have one or two examples to disabuse you of that notion]

Health Wonk Review is up...

Host David Williams, proprietor of the Health Business Blog, hosts this week's round up of health care policy and polity. David weaves together a lot of posts into something that really flows like an intimate discussion. I really liked that.

I was intrigued by Jason Shafrin's finding that more isn't always better. He takes a look at how much is spent on treating End Stage Renal Disease, as compared to treatment success rates, and draws an interesting conclusion. Might this also be true of other chronic conditions?

Unconscionable.

According to CMS (formerly HHS), the Emergency Medical Treatment & Labor Act (EMTALA) was enacted "to ensure public access to emergency services regardless of ability to pay." The law dates back some 20 years, and is the standard for ER accessibility. EMTALA doesn't, however, dictate the level of care to be given, other than that hospitals are "required to provide stabilizing treatment for patients with EMCs [emergency medical conditions]."

So what constitutes an EMC? "(D)eterminations of whether items and services provided in Emergency Departments (EDs) are reasonable and necessary...made on the basis of information available to the treating physician or practitioner." [ed: emphasis added] It doesn't really offer much more detail, but let's take a hypothetical example:

Suppose you were an ER provider (doc, nurse, whatever), and were presented with a woman writhing in pain on the floor, vomiting blood and moaning in agony. Would you agree that a reasonable and necessary reaction would be to ignore the woman for three quarters of an hour?

If you answered "yes," then you've got terrific company; namely, the folks in the ER at Los Angeles' Martin Luther King Jr.-Harbor Hospital and two different 911 dispatchers, who refused to send an ambulance to help the poor woman find some of that reasonable and necessary care. As a result, the 43 year old woman died of massive internal bleeding.

So what's the opposite of "Good Samaritan?"

Sometimes it's WHAT you know...

Recently, a client called to complain about a rate increase [ed: there's a first time for everything!]; his plan was barely 5 months old, yet his rate was going up on July 1st. I reminded him that we had upgraded his previous coverage in February, from a generic co-pay plan to an HSA-compliant high deductible plan. We hadn't changed carriers to do this, so his renewal date, which happened to be July 1, didn't change. Thus, his scheduled rate increase would take effect on July 1.

In the course of our conversation, he also complained about how the HSA itself was doing; he had chosen to use his credit union as his loss fund administrator, and they had "disallowed" his over the counter (OTC) meds. One of the selling points of HSA plans is the ability to run these items through the account, and thus garner some tax breaks. He had purchased cough medicine and other necessities, and the CU had informed him that these were "no-no's" for an HSA.

Now, I knew that these expenses were "kosher," but the CU had referred my client to IRS form 502, which does, indeed, disallow them. But 502 is not the operative form here, 213(d) is.

Hunh?!

Okay, let's step back a bit: although they're often conflated, "tax-deductible" is not the same as "pre-tax." That is, a deductible item comes off at the end of the year, when one files one's 1040 (or whichever). A pre-tax item comes off immediately, so there's no waiting. The point is, some medical items are "deductible," if one itemizes, and one's unreimbursed medical expenses exceed 7.5% of one's Adjusted Gross Income. I'm not an accountant, so I'll stop there.

In the event, the CU admin folks were referencing the wrong list in determining eligible items to reimburse. I knew that, but couldn't for the life of me find my copy of the correct, relevant list, the aforementioned 213(d). One would think that it would be all over the web, but that's not the case. Finally, a very nice lady at one of my carriers forwarded a copy to me, and I've made it available here.

HSA plans are insurance, and I sell those. But HSA loss fund accounts are not: they're money, and I don't sell them. I do keep a list of HSA resources, most of which come from my clients (who are kind enough to share their experiences with me). I don't know why this particular client chose his CU, but you can be sure that it won't be on my list.

Much ado about (not much)

We've addressed the issue of genes and underwriting before, so why bring it up again? Well, Dr Hsien-Hsien Lei (formerly of GeneticsAndHealth, and now at EyeOnDNA) is once again concerned about the use of genetic information in insurance underwriting. So what new information has come to light?

I'll let the good doctor fill us in:

"The US may soon be outlawing the use of genetic information to determine insurance eligibility but the debate still rages over at BMJ where [one] biomedical ethics professor...supports the principles of the Genetic Information Nondiscrimination Act (GINA) while [another] professor...does not."

[ed: BMJ is the British Medical Journal]

A quick search of Thomas (and Google) reveals that there's really not much actually happening with this issue, which doesn't surprise me (what with a presidential election coming up, and the recent brouhaha on immigration). I'm just not convinced that this is a particularly urgent problem.

I'm also unconvinced that it's any kind of problem: there seems to be a lot of fear-mongering on the issue in Dr Lei's post (although, to be fair, it's mostly in the comments section, by folks who are woefully ignorant of the underwriting process). These seem to boil down to two items of contention:

First, that somehow carriers will be able to use one's genetic info to make underwriting decisions about one's family members. Aside from the fact that this kind of information isn't shared among carriers anyway, it certainly isn't used to pit the insurance interests of family members at odds.

Second, to the extent that such information is helpful to an underwriter, it's in the realm of pricing (or whether or not to offer coverage at all). It's really no different than knowing whether or not the applicant is a smoker, or a diabetic, or recently had knee surgery. All of this goes into the mix, and genetic information may (or may not) play some role. There's nothing particularly sinister about it (and since I'm a member of a group in which this might be an issue, I can speak with some authority on the matter).

One of the folks involved in the BMJ debate, Prof Soren Holm, opined that "if we allow insurers to have some kinds of health information, such as a person's BMI or cholesterol level we no longer have any principled reason for excluding genetic information." I think that's exactly right: as noted, carriers need as much relevant information as they can get to adequately assess the risk.

That key word, "relevant", is important: underwriters really don't care whether you're a redhead, blond or bald. Neither the color of your eyes or your skin makes one whit of difference in your rate. Prof Holm concludes that "[g]enetic information is not special. It is not inherently more specific, predictive, sensitive or private than other kinds of health information." Right again: it's really no different than your height or weight, or whether or not you smoke.

The danger is that a carrier might conclude that, due to a genetic predisposition, one might become a diabetic, and therefore either decline, or charge more for, someone with that marker. As indicated before, this isn't legal here, nor is that likely to change.

In a related article, a potential insured asks if testing positive for a genetic marker for breast cancer would affect her future ability to purchase insurance. Aside from the legal reasons why this would not be the case, there are practical ones: insurance applications don't ask about genetic tests.

Again, there's just no there there.

Frankly, this seems to be a non-issue.

ADDENDUM: In re-reading this post, it occurs to me that it's unnecessarily harsh regarding Dr Lei's position. She posits an understandable (and often justifiable) skepticism about how insurers might use the results of genetic testing. Inasmuch as current laws pretty much prevent insurers from using such results, I don't share her concern.

On the other hand, if those restrictions were to be lifted, I would definitely want to reexamine the issue.

Unique Grand Rounds...

Val Jones, hostess of Revolution Health, has posted 2 (two!) versions of 'Rounds this week: there's the "Immediate Release" (a la Evelyn Woods) version, for those that just want to zip right through, and the more sedate "Extended Release," which includes context and commentary. You really can't go wrong with either one; both include 34 posts in 6 categories for easy perusal.

As a proud Trekker (true fans hate the term "Trekkie"), Nurse Ratched's post on ST:TOS character Nurse Christina Chapel (aka Mrs Roddenberry) as role model was convincing and obviously heartfelt. Plus, Nurse R has vowed to watch every episode of every ST iteration.

There's a very thin line between dedication and nuts.

Heartless or Pragmatic?

A Nashville woman seemingly has to choose between her family's financial well-being and a distant relative's health.

Pam Melson, who works at a Nashville-area clothing factory, would like to donate a kidney to someone at the far end of her family tree. The challenge is that the procedure would require her to miss quite a bit of work, and her employer is unwilling to guarantee that her job will still be there for her when she returns.

My first thought was that FMLA would apply, but that turned out not to be the case. Exacerbating the issue is that, by her own admission, Ms Melson has "missed more than a month of work this year, mostly to care for her three children when they were sick." Seems like she's got a few more issues than cousin Donnie (Hammack).

Cost of care doesn't seem to be an issue: Medicaid (i.e. you and me) is paying for the procedure. The challenge is really about job security. Does an employer have an obligation to hold someone's job who simply wants to play Good Samaritan?

And this isn't about nationalized health care, either: the gummint is already paying both Ms Melmick's and her cousin's med bills for the transplant.

For me, the key was this sentence: "Dr. Mark A. Wigger said Hammack could probably survive for another five years without a transplant." There's nothing particularly urgent about this, so I'm curious why Ms Melmick appears so bitter. I happen to think transplants are a great thing, and I applaud her altruism in wanting to help her cousin. But she also claims that she's "her family's sole financial provider....(and) can't afford to risk her job."

Seems to me, charity begins at home.

Carnival Monday - A Conundrum

First, the links:

The Carnival of Personal Finance is at Getting Green. It's a big, impersonal list of about 80 posts. It's categorized (sorta), but not usefully.

We're in it, but I'm not sure that's such an accomplishment.

And the Carnival of the Capitalists is up at Scatterbox (cool name. BTW). We're not in that one, but our good friend Joe Kristan (Roth & Co) is, and his post warning about dubious emails is a must-read.

Now the conundrum:

I like carnivals. I think they help expose readers to new (to them) blogs, they increase traffic for blogs that may not be so well-known, and gosh-darn-it, they're fun.

Having instigated a carnival, and having hosted several editions of both it and another, I know that putting one together can be tedious. Most of us have "real jobs," so we can't spend too many hours on reading, digesting, and summarizing a ton of links.

And so, a host's dilemna:

Include every post that's submitted (as long as it's in some way relevant), or play editor, and post only a select few?

The former has the benefit of being easy, and it avoids hurting folks' feelings (if everyone's in, then no one got left out). The latter has the benefit of relevance, and easier compilation for the host, and readability for the visitor.

This week's Carnival of Personal Finance is an example of the "just throw it all in the pot" model. There's obviously no attempt to cull out good (relevant) posts from bad (irrelevant) ones. This is evident from the fact that no summaries are included. The result is a huge "link dump," which I daresay few people are going to slog through. Much as I like that we're included (as we were not for the Capitalists), it's really to damn with faint praise.

In the past few months, we've only made it into the Carnival of the Capitalists once or twice. Sure I'm disappointed, but the posts that were included seemed relevant, and the host provided helpful context. The problem is that we'll never know what other posts, that didn't make the cut, were also worth reading.

I don't have any really good answers. Perhaps something "down the middle:" give the host some editorial discretion and specific guidelines, and tell them to pick the best (most relevant?) 15 or 20 for the actual Carnival, but provide a listing of all the other entries (with any summaries their contributors included) in either a separate post, or as an addendum to the Carnival.

Just some (carnie) food for thought.

Irrelevant, but Frustrating

Okay, this has NOTHING to do with insurance, but it does relate to customer service and, more critically, goodwill.

Our home is warm, inviting, comfortable, and almost 50 years old (much like its owners). Unfortunately, some of the existing telephone wiring dates back to Bell & Watson, which has caused us, over the years, to purchase approximately 897 cordless phones, hoping to find "the one" that will work without interference.

Imagine my delight in finding that the new DECT (Digital Enhanced Cordless Telephone) technology offers exactly the kind of performance for which I'd been so fruitlessly shopping. I looked around, and found a very cool GE model (sleek, flat, black and BOSE-quality sound). I bought the single base unit because I've been burned before, and didn't want to eat two phones.

No worries, it works flawlessly.

Well, except for one small detail: I have looked all over the web for the expansion handset, visited every local brick-and-mortar, and come up completely empty-handed.

No problem, I'll just drop GE an email asking where to purchase a model #28106. I was that specific in my email. Here's their (idiotic) reply:

"Thank you for your recent inquiry about where to buy GE telephones. GE Telephones can be purchased from retailers such as Wal-Mart, Target, RadioShack, etc... You can also purchase GE products from www.home-electronics.net. If you are looking for GE Telephone Accessories (such as optional handsets, replacement batteries, headsets, etc...), there is an Accessory Order Form in the back of your instruction book to order by mail or you can call our toll-free number (1-800-338-0376) to order by credit card."

Um, NO!!! you can't. None of these stores stock this item, either on the web or down the street. And when I call your stupid 800 numbers, they refer me to other 800 numbers, which refer me back to the original one. I did manage to find one -- just one -- actual human being (Chris) who pointed me to Pronto.com. They do have quite the selection, just not (apparently), the one I want.

What's so utterly frustrating is that GE had (apparently completely by accident) built an enormous amount of goodwill with their product, which they've now squandered by making it well-nigh impossible to buy another (compatible) product.

I wonder if there's a lesson in this.

Common Knowledge: Disability Insurance

In the classic SNL skit, "(q)uestions for our show are show are selected by educators from Princeton University to express a broad range of common knowledge that every American should possess. Answers for Common Knowledge are determined by a nationwide survey of 17-year-old high school seniors."

The Council for Disability Awareness is made up of folks a bit more knowledgeable than the average HS senior, and they've put together an interactive quiz to help you determine whether you have adequate income protection if you're severely injured, or contract a dread disease.

The Disability Awareness Quiz is an online tool to help you find out, and it takes just a few minutes. Might I suggest that you find a few such minutes this weekend, pop over and take the quiz, and maybe let your fellow IB readers know what how you fared?

The (New) Carnival of Trust

Don't know how I missed this, but there's a new blog carnival in town, The Carnival of Trust. It's slated to run on the first Monday of each month. The CoT's goal is to highlight "the ten most interesting, provocative, thoughtful blog postings within four broad categories of the subject of trust: Advertising and Influencing, Sales & Marketing, Leadership & Management, and Strategy, Economics & Policy."

The first issue, hosted by CoT founder Trusted Advisor, is available now. Recommended.

As a salesman myself, I was intrigued with and impressed by this post on "the anti-sales pitch." Natalie Ferguson, blogging at Simple and Loveable, explains.

Mini-Meds under fire?

According to USA Today, police officers should stop trying to catch bank robbers, airlines should ground their fleets, and doctors should desist from operating on seriously ill patients.

Oh, and we Americans are too stupid to be allowed to buy (or refrain from buying) our own health insurance.

Think I'm kidding?

Well, that's the logic behind this article, which starts out by painting its putative hero as an idiot:

"Then the Michigan couple began getting bills from doctors and the hospital, for more than $8,000. To his surprise, Camilleri's insurance didn't cover any of it because his wife had surpassed a $2,500-a-person annual limit on what the policy would pay."

"To his surprise." Translation: they bought an insurance product and never bothered to read what it did, and did not, cover. Now, I know that no one reads all the mice-type, but surely folks should at least familiarize themselves with obvious limitations, which annual limits like this would certainly comprise.

"Limited benefit medical plans" (or "mini-meds," about which we've written before) are not new, but they've been revitalized as folks look for cheaper ways to purchase insurance. There's nothing inherently wrong with looking for a bargain (hey, if there was, then so long Ebay); but that shopping must be tempered with the axiom that "you get what you pay for." That is, if a product is markedly less expensive than comparable plans, then there's probably a very good reason, and that very good reason is not going to redound to your benefit.

Does that mean that mini-meds are inferior? Not necessarily, but the key word in "limited benefits" is limited.

But wait, it gets better (or worse, depending on one's perspective). According to Citizens for Economic Opportunity's Beverley Brakeman, when they purchase a mini-med plan "people think they have insurance, get sick and find out that they don't." Um, no: when they purchase a lesser product (such as a mini-med) and pay a lower rate because of its limitations, they've bought insurance. It's like saying "people that rented a small apartment instead of buying a big house are homeless."

It's quite the conundrum: at a given moment, we have "x" number of folks who are, either by choice or happenstance, without insurance. The industry, under seige for not adequately addressing the issue, rebrands and remarkets a scaled-back benefit plan that enables almost a million people to purchase at least some form of coverage. And the response? "Not good enough."

So, why the hysterical comments in the first sentence? Well, let's think about it: insurers market a product with a lower price tag (and lower benefits and caps) and manage to insure a non-trivial number of people. Not every uninsured person, but a decent chunk. And the response from the sidelines: "Not good enough." That's exactly like saying that since the cops can't catch every burglar, they should stop trying to catch any burglars. And since the airlines can't guarantee that every flight will arrive safely and on time, they should stop flying altogether.

Well, you get the point.

ADDENDUM: I just re-read Bob's post on how Massachusetts' foray into state-sponsored health insurance has left a lot of young folks with stupendous uncovered (and unpaid) expenses. The plans are problematic "because of annual limits and caps on outpatient care and surgeons' fees."

"Annual limits?" "Caps on...care?" Sound familiar?

So how come when the insurance industry pushes these it's a nightmare, but when the gummint implements them it's "progress?"

Cavalcade of Risk: 1st Anniversary Edition

As our good friend Julie pointed out a few weeks ago, the 26th bi-weekly edition could have been considered our anniversary issue, as well. But I tend to look at these things in terms of time passing, and it was a year ago this week that we published the first Cav.

We've come a long way since then, with lots of great hosts, and I want to thank each of you for your help and support, and your willingness to help out. I'm really looking forward to this coming year, as well, as more folks jump on our mailing and hosting lists.

As CoR hosts know, I spend the weekend before each Cav "hunting" for interesting/unusual risk-related posts from around the blogosphere. These are often included along with those submitted by our "regulars." Since this is our anniversary edition, though, I'm sticking exclusively with posts submitted by you.

Thank you for a great year!

And now, the 1st Anniversary Cavalcade of Risk:

■ The title of this post alone earned it top billing here. My Wealth Builder's "Super Saver" explains how asset allocation techniques can help take some of the risk out of retirement planning.

■ Over at the New York Personal Injury Law Blog, Eric Turkewitz tells the tale of an insurance company that wants to settle, and a doctor that doesn’t. The insurer settles anyway. The doctor sues.

■ Hurricane Katrina continues to cause risky ripples. Dr J C, at GNIF Brain Blogger, explores a unique and unusual case involving the failure to evacuate a patient. Was it malpractice, or good medicine?

■ Leon Gettler, blogging at Sox First, says that cross-border fraud is now one of the top 10 business risks, but according to a new study, most companies are not prepared to deal with it.

■ With a subject close to my own heart, Charles H. Green (Trust Matters) avers that systemic insurance fraud won't stop until we make it stop.

■ Bryan Moore, The Financial Whiz, writes about a risk-management approach to investing, using "Hedge Fund" Mutual Funds that are currently available to the small retail investor.

■ Over at the Boston Erisa blog, Stephen Rosenberg examines the roles of risk, liability, and (of all things) climate change. You'd be surprised.

■ HWR regular Jason Shafrin asks "How does insurance company physician reimbursement restrictions affect the cost of influenza vaccinations?" He calls on Adam Smith and Jonas Salk for answers.

■ The Health Business Blog's David Williams has a question, too: Did you know that collaborating with a cardiologist can be like collaborating with a rattlesnake? That's what some radiologists seem to think.

■ Chocolate or vanilla? Ginger or MaryAnne? Stockmarket or Real Estate? In his favorite risk post from the past year, our friend The Silicon Valley Blogger attempts to discern which investment strategy is the better risk. Click to find out.

■ The Cato Institute's always provocative, always interesting, Michael Cannon shares his thoughts on how HSA's (Health Savings Accounts) can be used to help reduce folks' health risks.

■ Julie Ferguson of Workers' Comp Insider takes the industry's pulse to see what lies ahead for employers and insurers. In her post, Julie observes that the worker’s comp market continues to be robust, but there’s still some risky waters ahead.

■ Meanwhile, in her favorite risk post since we started the Cav, Susan Mangiero of Pension Risk Matters highlights a survey indicating that risk still worries some institutional investors.

■ And Jay Norris, over at Colorado Health Insurance Insider, discusses the recent passage of (CO) House Bill 1330, the "second parent adoption bill", the steps Colorado is making to rise above bigotry in the health insurance industry, and what still needs to be done.

■ And finally, here at IB, our own Bob Vineyard has some thoughts on Atlanta’s least favorite lawyer, Andrew Speaker, the erstwhile globe-trotting TB carrier. Bob explores some of the risks Mr S took, as well as those he forced on his fellow passengers.

That about wraps up our First Anniversary Edition. Please join Julie, at Workers Comp Insider, on the 20th for the next star-studded issue.

CATO on HSA's: Bigger = Better

The Cato Institute (yes, we're familiar with it), a well-known libertarian think-tank, has proposed some sweeping changes to Health Savings Accounts.

And we do mean "sweeping;" frequent Cavalcade of Risk and Health Wonk Review contributor Michael Canon suggests:

■Increasing the allowable HSA contribution limits dramatically, to $8000 for individuals and $16,000 for families. That's about triple current levels.

■ Removing the requirement that HSA holders be required to own HDHP's (High Deductible Health Plans); anyone could own an HSA, regardless of coverage configuration.

■ Allowing HSA holders to purchase health insurance of any type from any source, tax-free with HSA funds. This is a dramatic change: currently, only long term care (and COBRA) premiums can be paid tax-free from HSA accounts.

These are some aggressive changes, not all (or maybe any) of which will be welcome by the pundit and political classes. Frankly, I'm not sure that the first one is really necessary: there are precious few plans even available with such high deductibles; how many folks are going to be opting for those? Right or wrong, that's bound to upset the class-warriors.

The second one is intriguing: my first reaction was negative, but I couldn't figure out why. It occurred to me that it was visceral: I've been promoting and defending HDHP's for so long, I think I took that personally. Bad idea.

The final suggestion seems pretty innocuous: what harm could that do? So many folks are already moving to "higher" deductible plans (e.g. $1,000/person) that this would seem to be pretty easy to justify.

Michael is always forward-thinking, and he may be on to something here.

Grand Rounds is up...

Dr Lisa Marcucci presents over 30 interesting posts from around the medblogosphere (yeah, I really like that term). Each one has a succinct "thumbnail" for context (I like that, too), and the posts are neatly categorized for easy perusal.

Our friend Jay Norris, blogging at Colorado Health Insurance Insider, tells us about his own less than satisfactory experience with transparency in medical care pricing. Enthususiastic as I am about consumer empowerment, this post really points out that we still have a way to go.

Zero Premium Life: Update the 2nd

As the continuing saga of ZPL, um, continues, we find the ever-vigilent Peach State Department of Insurance following the leads of North Carolina, Iowa and others:

"The Department has received a number of inquiries from Georgia resident licensed agents who have been solicited through e-mail and facsimile transmitted advertisements to sell Zero Cost, No Cost, No Premium, Zero Premium or Zero Payment insurance coverage to their clientele...[and] has opened an investigation to ascertain whether, and the extent to which, these solicitations directly violate any Georgia Statutes and Regulations applicable to the sale of universal or whole life insurance products."

The Department also strongly urges agents to "refrain from entering into any agreement or arrangement to market or sell" these products. Contrary to the implications of the marketers' emails, these products have not been approved for sale in Georgia (or anywhere else, as far as we can determine).

A few weeks ago, the Kentucky DOI also joined the fray, advising agents in the Bluegrass State that the agency is "currently investigating the sales material and the practice in general to determine if there are any violations of Kentucky’s insurance law." They're also requesting that agents forward any relevant sales and/or marketing materials to the department. I like that: it's proactive, and it empowers agents to help their own cause.

Meanwhile, back here in the Buckeye State, the never-vigilant Ohio Department of Insurance continues to ignore the whole brouhaha. Rarely have I been so proud.

Carnival of Personal Finance: Ambitious Edition

Jack Bauer, er, uh, I mean Clever Dude, presents a clever, well-designed, really fun Carnival this week. Based on the hit TV show "24," CD (or is that CTU?) uses the ticking clock metaphor to present over 5 dozen entries. And each one explains the post in the context of the show.

Absolutely amazing (and some great visuals, to boot!). Do check it out.

Do you know the difference between "frugal" and "cheap?" You might be surprised: The Frugalist explains that being economical doesn't necessarily mean being stingy.

Hoax or Outrage?

By now, most folks are probably aware of the recent Dutch "game show" wherein ESRD patients vied for new kidneys from a terminally ill donor. The idea was that, by presenting themselves as the "most worthy" (or whatever), one lucky contestant would win a new set of kidneys, and thus a new lease on life.

As it turns out, the show was actually an elaborate hoax, designed to point out some of the shortfalls of the Dutch organ donor system. The "terminally ill donor" was, in fact, an actress; the patients, though, really were transplant candidates, who agreed to debase themselves for the sake of ratings (and, perhaps, a few Euros). The fact that this was staged, however, only exacerbates the moral issues at play.

In Holland, as here, organ transplants are tightly regulated, with the added complication of relevant EU regulations thrown in. The show points up some pretty significant ethical problems, and a few insurance ones, as well:

For one thing, there is the tension of the greater good versus the wellbeing of the individual. As we saw with the Zero Premium Life kerfluffle, there is a very real danger of "non-voluntary donors." The urban legend about waking up in a hotel room sans kidneys may be merely a myth now, but absent rigorous safeguards, is it all that unlikely?

From an insurance standpoint, most major medical plans cover transplants (often restricted to "Centers of Excellence") which pay both the donor's and recipient's medical costs (although the donor also incurs additional, unreimbursed expenses, as well). But such procedures are done under strict guidelines, and carriers generally have special claims units specifically for these types of claims.

Still, there is no question that there are a lot of folks who need kidneys, hearts, livers, corneas...the list goes on. So why don't more folks donate their organs (either while they're alive, or arranged for posthumous harvesting)? Well, some may pass for religious reasons, others may never have even considered it. And, as with life insurance and wills, there are a certain number of folks who just don't want to even think about their own mortality, and thus choose to ignore the issue altogether.

Which brings us back to the little Dutch "stunt." The producers claim that its real purpose was to increase awareness of the need for more donors. Based on the public outcry the show elicited, I'd say they made their point. The question is, however, whether more people were convinced, or turned off.